Dermato-Venereology in the Nordic Countries
Controversies and Challenges in Venereology in Denmark
Kristian Kofoed 1 and Helle Kiellberg Larsen 2
1
Department of Dermatology , Venereal Clinic , Herlev and Gentofte Hospital , University of Copenhagen , and 2 Department of Dermato-venereology , Bispebjerg and Frederiksberg Hospital , University of Copenhagen , Denmark
In recent years several challenges and controversies have arisen in the field of venereology in Denmark . Some of these challenges appear to be unique for Denmark , while others have also arisen in the other Nordic countries . Of course , it is possible that the issues faced in Denmark today may arise in other Nordic countries in the future .
Human papilloma virus
In February 2016 , the human papilloma virus ( HPV ) vaccine was changed in the Danish childhood immunization programme ; Gardasil was replaced by the vaccine Cervarix . Cervarix protects against the two oncogenic HPV types 16 and 18 that are responsible for approximately 70 % of all cervical cancers ( 1 ). The two vaccines are similar with regards to the level of protection against cervical cancer and reported side-effects . However , unlike Gardasil , Cervarix does not protect against genital warts . When Gardasil was originally introduced into the Danish childhood immunization programme there was a significant decline in genital warts among both young women and men ( 2 ). Following the change of vaccine to Cervarix , it is likely that the incidence of genital warts will increase once again . It is planned that all girls who have already received at least 1 dose of Gardasil are to be completed with this vaccine before the end of January 2017 .
However , no matter which vaccine is included in the programme it will have no effect if the girls are not vaccinated . In Denmark the HPV vaccine is given at the age of 12 years . Statistics from Statens Serum Institute from April 2016 show that only 27 % of girls born in 2003 received the HPV vaccine . Thus , due to the low level of vaccine uptake , an alarming number of deaths from cervical cancer will not be prevented .
Until April 2016 , a total of 242 women filed claims for HPV vaccine side effects to the Danish Patient Compensation Association , which decides compensation claims for patients injured in connection with treatment by the Danish Health Service . For comparison , only 37 persons in Sweden and 8 in Norway have filed a claim until April 2016 ( Danish Broadcasting Corporation , 23 April 2016 ).
In November 2015 , the European Medicines Agency ( EMA ) released a new evaluation report on the safety of HPV vaccines . This reevaluation was done on a Danish initiative . The report concluded that the available evidence does not show that HPV vaccines are linked to the suspected serious side-effects postural orthostatic tachycardia syndrome ( POTS ) and complex regional pain syndrome ( CRPS ). In particular , the syndrome complex POTS was debated in Denmark in 2015 . The conclusion drawn by the EMA was based on a thorough review of the published research articles , data from the companies ’ clinical trials , and suspected adverse reactions reported by patients and doctors , as well as additional data provided by member countries , including Denmark . The EMA also consulted with a group of leading experts in the field of vaccines , POTS and CRPS , and assessed the detailed information received from a variety of patient groups . In December 2015 , the World Health Organization ( WHO )’ s Global Advisory Committee on Vaccine Safety ( GACVS ) pronounced on the safety of HPV vaccines . Like the EMA , GACVS concluded that , based on existing knowledge , there is no evidence of safety problems with the vaccines that would support changing the vaccines . Vaccine safety is monitored closely by both the EMA and the Danish Medicines Agency . Scandinavian doctors should therefore not be afraid to support national HPV immunization programmes .
Syphilis
Syphilis has been known in Europe for over 500 years . In 1530 the Italian physician Girolamo Fracastoro portrayed the disease symptoms in a poem about the shepherd Syphilus , who later became the eponym of the disease . The exact origin of syphilis is unknown ; one hypothesis is that the disease was carried to Europe by returning crewmen on the Santa Maria from Christopher Columbus ’ s voyage to the Americas . Syphilis , which also became known as the French disease , the Gallic disease and the Great Pox , spread rapidly as a deadly epidemic across Europe ( 3 ).
This , in brief , is the historical description of syphilis . In the 1990s syphilis appeared to be predominantly a disease of historical interest , since it was considered almost extinct in
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